Private Medical Center Research Articles

The making of an imagined community: The press as a mediator in ethnographic research into Assisted Reproductive Technologies (ART)

The purpose of this article is to discuss the concept of community as a methodological tool in the absence of a face-to-face interaction context. Our perspective emphasizes the constitutive role of the researcher and his or her methods in creating communities in any kind of social research. In our case study of research that we conducted in a private medical centre in Barcelona, we show how Assisted Reproductive Technologies (ART) users were ‘imagined’ as a community through the use of press clippings as mediation tool in the ethnographic interview.

The influence of total quality management (TQM) on operational flexibility in Jordanian hospitals

PurposeThe importance of total quality management (TQM) to organizational achievement and performance has been established by many studies. Nevertheless, studies on the implementation of TQM and its relationship to operational flexibility have been limited, particularly in the developing countries. The purpose of this paper is to address this gap by exploring the extent of the application of TQM and its influence on operational flexibility in Jordanian hospitals.Design/methodology/approachThe study covers both public (King Abdullah University Hospital) and private (Jordan Hospital and Medical Center) health care services. A survey was conducted using a quantitative approach where the researchers distributed 400 questionnaires to selected respondents. The response rate was 57 percent out of the total questionnaires distributed. TQM is an independent variable which consists of eight principles, namely, leadership, employee management, information analysis, training, customer focus, continuous improvement, process management, and supplier management was examined in relation to operational flexibility as a dependent variable which comprises external flexibility and internal robustness.FindingsThe findings reveal that there is a significant positive relationship between TQM and operational flexibility. The authors conclude that TQM practices significantly influence the intensity of operational flexibility in Jordanian hospitals.Originality/valueThe significant impact of TQM on operational flexibility has been argued to be positive. The value of the paper is that it points out the influence of TQM on operational flexibility in Jordanian hospitals in order to improve hospital performance and efficiency.

Report on the Society for Education in Anesthesia Spring Meeting 2009: “Educating About Safety: Educating Safely” Cosponsored by the Anesthesia Patient Safety Foundation, University of Washington Medical Center and Virginia Mason Medical Center, Seattle, WA, June 4–7, 2009

Report on the Society for Education in Anesthesia Spring Meeting 2009: “Educating About Safety: Educating Safely” Cosponsored by the Anesthesia Patient Safety Foundation, University of Washington Medical Center and Virginia Mason Medical Center, Seattle, WA, June 4–7, 2009

Diagnostic Endoscopy in Children of Two Months to 15 Years of Age

Problem statement: Considering high prevalence of gastrointestinal complaints in children and the important role of endoscopy in the diagnosis of such complaints, this study was designed to characterize the clinical, endoscopic and pathologic features of Iranian children undergoing upper Gastrointestinal (GI) endoscopy. Approach: This prospective study was performed in an office-based setting in a private medical centre in Kerman, Iran, between December 2004 to January 2008. Three hundred forty pediatric patients who underwent upper endoscopy for dyspeptic symptoms or other reasons were enrolled into this study and data were gathered concerning age, sex, reason of endoscopy, endoscopy report and pathologic report. Upper GI endoscopy was performed using Pentax video endoscope. Results: The most prevalent reason of performing endoscopy (43.1%) was abdominal pain. More than half of the cases with abdominal pain (54%) were in the age range of 5-10 year old of whom 80% had an abnormal pathologic finding such as esophgitis and active chronic gastritis associated with helicobacter pylori. The most common endoscopic finding (31.2%) and pathologic finding (40.3%) was esophagitis. More than half of the children with esophagitis (56.6%) had some degrees of hiatal hernia. In 35.5% of children with nodular gastritis, simultaneous esophagitis was observed. The rate of normal endoscopies and pathologies were respectively 10.8 and 19.4%. Conclusion: Considering low rate of normal endoscopic and pathologic reports in the studied subjects and also the variety of gastrointestinal complaints in them, it seems that proper selection of patients for undergoing upper GI endoscopy can have a significant directive role in the diagnosis of pediatric problems.

Prevalence of High-Grade Anal Intraepithelial Neoplasia (AIN) in Anal Lesions in HIV + Men Who Have Sex with Men (MSM) from a Venezuelan Private Medical Center

Prevalence of High-Grade Anal Intraepithelial Neoplasia (AIN) in Anal Lesions in HIV + Men Who Have Sex with Men (MSM) from a Venezuelan Private Medical Center

Prevalencia de infección cervical por Chlamydia trachomatis en mujeres de la Región Metropolitana

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) worldwide. In women, chlamydia infections are 75% asymptomatic and can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. Infants exposed to the microorganism at birth also have a high risk to develop conjunctivitis and pneumonia.To determine the prevalence of C trachomatis in women in the Metropolitan area of Santiago (Chile).Cervical specimens were collected from 403 women attending three gynecological outpatient settings from April 2003 to June 2005. These included one public hospital (n=100), a private medical center (n=268), and a clinic for adolescents (n=35). Mean ages of each group of patients were 35.6+/-8,2, 33.4+/-8.1 and 16.9+/-4.2 years, respectively. The diagnosis of C trachomatis was performed by the amplification by PCR of a 517-base pair segment of the cryptic plasmid on specimens extracted by a commercial procedure. Positive specimens were confirmed by nested PCRs targeting the ompl gene. The presence of vaginal infections and its association with C trachomatis was investigated in a subset of 223 women of the private center.C trachomatis was detected in the cervix of 19 out of 403 women, resulting in a prevalence of 4.7%. The distribution of positive cases among different age groups was not significantly different. Women presenting with bacterial vaginosis had a significantly higher prevalence of C trachomatis infection (p<0.01).This study found a high prevalence of C trachomatis among gynecologic patients that should prompt preventive strategies.

Prevalence of cervical infection by Chlamydia trachomatis among Chilean women living in the Metropolitan Region

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) worldwide. In women, chlamydia infections are 75% asymptomatic and can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. Infants exposed to the microorganism at birth also have a high risk to develop conjunctivitis and pneumonia. To determine the prevalence of C trachomatis in women in the Metropolitan area of Santiago (Chile). Cervical specimens were collected from 403 women attending three gynecological outpatient settings from April 2003 to June 2005. These included one public hospital (n=100), a private medical center (n=268), and a clinic for adolescents (n=35). Mean ages of each group of patients were 35.6+/-8,2, 33.4+/-8.1 and 16.9+/-4.2 years, respectively. The diagnosis of C trachomatis was performed by the amplification by PCR of a 517-base pair segment of the cryptic plasmid on specimens extracted by a commercial procedure. Positive specimens were confirmed by nested PCRs targeting the ompl gene. The presence of vaginal infections and its association with C trachomatis was investigated in a subset of 223 women of the private center. C trachomatis was detected in the cervix of 19 out of 403 women, resulting in a prevalence of 4.7%. The distribution of positive cases among different age groups was not significantly different. Women presenting with bacterial vaginosis had a significantly higher prevalence of C trachomatis infection (p<0.01). This study found a high prevalence of C trachomatis among gynecologic patients that should prompt preventive strategies.

Neurologic impairment from ectopic bone in the lumbar canal: a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2 (BMP-2)

Background context Bone morphogenetic protein-2 (BMP-2) (Infuse) has been approved for use in anterior lumbar fusion in conjunction with an LT cage. However, off-label use is seen with anterior cervical fusion, posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF). The Federal Food and Drug Administration trial of BMP-2 in a PLIF application was halted because of a high incidence of ectopic bone forming in the neural canal (75%). The authors did not find a correlation between ectopic bone and increased leg pain. They concluded that the ectopic bone was a radiographic phenomenon and not associated with clinical findings. Complications using BMP in the cervical spine have been reported. Heretofore, there has not been a similar warning voiced for use of BMP in a lumbar PLIF or TLIF. Purpose The purpose was to report five cases of ectopic bone in the canal associated with PLIF/TLIF off-label use of BMP-2 potentially contributing to abnormal neurologic findings. Study design/setting This is an observational cohort study of patients referred to a tertiary care private medical center. Methods This was a retrospective chart review of patients referred to a tertiary spine institute with complications after surgery where BMP-2 had been used in an off-label PLIF or TLIF application. Patient demographics, operating room (OR) notes from the index BMP surgery, imaging studies, and current clinical status were reviewed. Results Five cases of ectopic bone in the spinal canal with potential neurologic compromise were identified. Conclusions It does appear that ectopic bone in the spinal canal associated with BMP-2 use in PLIF or TLIF may contribute to symptomatic neurologic findings in rare cases. Revision surgeries are difficult. This article challenges a previous publication, which concluded that the high incidence of ectopic bone was of no clinical significance. Isolating BMP anteriorly in the disc space using layered barriers of bone graft between the BMP and the annular defect may reduce the incidence of ectopic bone in the spinal canal. Surgeons need to weigh the benefits versus risks of any technology used off label when making treatment decisions with their patients.

Five-year surveillance of nosocomial infections following orthopedic surgery in a private medical center

Introduction Nosocomial infections (NI) are a major problem in health care facilities, resulting in extended length of stay, substantial morbidity and mortality, and excess cost. In this study, we aimed to know the rates, distribution profiles of NIs following orthopedic surgery, and share our first 5-year experience, in a private medical center.

The Decrease in Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infections and Savings From Glycopeptide Use

We evaluated changes in the rate of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections and healthcare-associated S. aureus infections after implementation of infection control precautions and the effect of this on glycopeptide use and expenditures for glycopeptides in a private medical center in Turkey in the years 2000-2005. A striking decrease was obtained in the number of MRSA infections, and the expenditure for glycopeptide use also decreased.

Actual Versus Instructed Fasting Times and Associated Discomforts in Women Having Scheduled Cesarean Birth

To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting. One group, nonexperimental, comparative, descriptive. Nonprofit private medical center in Texas with 6,000 births/year. Convenience sample of 51 hospitalized postpartum women. Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information. Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger. The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale. Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.

Complementary and alternative medicine use by patients with inflammatory bowel disease: Results from a postal survey

Thirty to 50% of north American patients with inflammatory bowel disease (IBD) have been reported to use complementary and alternative medicine (CAM). There is no data in France. The aim of this study was to evaluate the frequency of CAM use and the reasons in a French population of patients with IBD. An anonymous postal survey was done with a questionnaire mailed to all the patients with IBD, 16 to 79 year-old, followed-up in a public and a private medical centre of Reims, between January 2001 and December 2003. The final sample included 447 patients; 325 (72.7%) filled up the questionnaire: 219 (67.4%) had Crohn's disease, 94 (28.8%) ulcerative colitis and 12 (3.7%) indeterminate colitis. Sixty-nine patients (21.2%) reported CAM use for IBD. The mean number of CAM used simultaneously was 2.9. The most frequently used CAM treatment was homeopathy (40.6%), followed by magnetism (34.8%) and acupuncture (33.3%). The majority of patients (74.8%) never talked about CAM use with their IBD physician. Multivariate analysis showed that the factors significantly associated with CAM use were female gender (odds ratio (OR)=3.5, CI95%: 1.8-6.9), the low level of confidence in their doctor (OR=4.8, CI95%: 1.1-19.8) and the research of informations about their disease (OR=4.6, CI 95%: 2.0-10.7). Twenty-one percent of patients with IBD are using CAM, most of the time without talking about it with their physician. The quality of the relationship between the patient and his physician and female sex, more than the perceived severity of the disease, were the main determinants of that use.

Provision of Peripheral Blood Stem Cell Service in Developing World: Experience from a Private Medical Center in Malaysia.

Stem cell transplants (SCT) are potentially life-saving procedures but the availability of such services is limited in the government sector in Malaysia. The cost and logistics of having SCT abroad are daunting. This paper outlined our experience in setting up a SCT unit in a private hospital and reporting on the first hundred cases done over a 4 and a half year period from 1999 to 2004. All cases of SCT were performed with peripheral blood stem cells and in 5 cases (5%) back- up marrow was necessary as <2X10^6 per kg of CD34 positive PBSC was harvested. Autologous SCT was performed on 66 cases for the following indications i.e. Non Hodgkin's lymphoma (37), Acute myeloid Leukemia (13), multiple myeloma (10) and Hodgkin's lymphoma (6). Thirty four allogeneic SCT were performed for AML (16), chronic myeloid leukemia (8), acute lymphoblastic leukemia (4), Non Hodgkin's lymphoma (4), Myelodysplastic syndrome (1) and aplastic anaemia (1). Twenty of the allografts were conventional SCT while 14 had reduced intensity allografts. Transplant related mortality (TRM) was recorded in 4 cases (13.6%) of allogeneic SCT. Three of the deaths were sepsis related. No TRM was seen in autologous SCT. The direct medical cost (included stem cell harvest and the first 3 months post transplant care) of autologous SCT was a mean of US$ 16000 (ranged from US$ 9000 to US$ 20000) while allogeneic SCT cost a mean of US$ 25000 (ranged from US$ 20000 to US$ 60000). Our experiences indicated that SCT is feasible in a private medical center in a developing nation—the SCT results were comparable with established centers but with substantial cost saving as compared with SCT done abroad.

Risk analysis of a patient monitoring system using Bayesian Network modeling

In a modern technological environment where information systems are characterized by complexity, situations of non-effective operation should be anticipated. Often system failures are a result of insufficient planning or equipment malfunction, indicating that it is essential to develop techniques for predicting and addressing a system failure. Particularly for safety–critical applications such as the healthcare information systems, which are dealing with human health, risk analysis should be considered a necessity. This paper presents a new method for performing a risk analysis study of health information systems. Specifically, the CCTA Risk Analysis and Management Methodology (CRAMM) has been utilized for identifying and valuating the assets, threats, and vulnerabilities of the information system, followed by a graphical modeling of their interrelationships using Bayesian Networks. The proposed method exploits the results of the CRAMM-based risk analysis for developing a Bayesian Network model, which presents concisely all the interactions of the undesirable events for the system. Based on “what–if” studies of system operation, the Bayesian Network model identifies and prioritizes the most critical events. The proposed risk analysis framework has been applied to a vital signs monitoring information system for homecare telemedicine, namely the VITAL-Home System, developed and maintained for a private medical center (Medical Diagnosis and Treatment S.A.).

Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey

Florence Nightingale Hospital is a 300-bed, university-affiliated, private medical centre with a large open heart surgery programme in Istanbul, Turkey. In this study, the mortality rates, lengths of stay (LOS) and extra costs of patients with deep sternal surgical site infections (DSSSIs) and superficial sternal surgical site infections (SSSSIs) following coronary artery bypass grafting (CABG) were determined from January 1999 to December 2002. Group I included 52 patients with DSSSIs, Group II included 36 patients with SSSSIs and Group III included 88 controls. The controls were selected at random from patients operated within the same year, with the same sex and age within five years, but who had not developed infection. Mortality rates in Groups I, II and III were 19.2%, 0% and 4.5%, respectively; the mortality rate in Group I was significantly different from that in Groups II and III (P<0.005). LOS was 47, 33 and 12 days for Groups I, II and III, respectively, and LOS was statistically different for each group (P<0.005). The costs of extra LOS, antibiotics, and radiological, microbiologial and other laboratory examinations for Groups I and II were US$6850.93 and US$3740.58, respectively. Both DSSSI and SSSSI following CABG extended the LOS and increased the cost, and DSSSI was significantly associated with a high mortality rate. These results suggest the need for improved infection control measures to reduce SSSIs following CABG. As an important component of the extra cost is the extra LOS, it is essential to shorten this period. This may be particularly applicable in patients with SSSSIs.

A Study of Risk Factors Concerned the Onset of Periodontal Infection in the Least Developed Countries: The First Report-The Influences of the Living Environments Risk Factors at Rural Area in Kingdom of Cambodia-

General Principles and Objects : According to the background of the crisis in periodontal infection, it is necessary to conceptualize the risk management concerning relationship between various risk factors and systemic damages in rural areas of the least developed countries. The Organization of International Support for Dental Education (OISDE), in cooperation with Japan International Cooperation Agency (JICA), has started to implement a primary health care program focused in the prevention of systemic damages caused by periodontal infection since 2003 to stretch over one year and six months. The program has been applied to 7 provinces and 25 districts with beneficiary residents of over 1,300 according to the methodology. In this study, the targeted area was focused two typical rural health centers in Stung Treng province. The project had been implemented three times in these health centers since January 2004 to March 2005 and the number of residents who checked our examination and primary health care were 194. Sixty residents who live in the downtown of Phnom Penh city were served as control group in quite advanced living environment conditions.The purpose of this study is to investigate the influence of risk factors associated with poor living environment to the crisis in periodontal infection in rural area in the Kingdom of Cambodia as a field study.Methods : Basic information of all visiting residents was charted according to our original concept. Living environment (LE) risk factors were charted based on a five-grade method. The contents of LE were as follows : 1) medical supply condition which means the distance from the referred hospital including private medical clinic, health center and health post, 2) sanitary (toilet) facility, 3) provision of safe water supply, and 4) situation of living in close proximity with the livestock. Medical systemic conditions of the residents were charted by interview method into history of systemic diseases and history of tropical infections. Also, general health conditions including physical examination of the heart and lungs sound, measurement of blood pressure, urine test and simply ECG (electrocardiogram) were assessed by the physician. The dental intelligence quotient (dental IQ) concerning periodontal infection was charted by question and answer method according to a five-grade classification. The periodontal infection was evaluated by dentists using a four-point method measurement of periodontal pocket depth, bleeding on probing (BOP), and mobility of each tooth. Plaque-induced gingival inflammation was examined by plaque control record (PCR method by O'Leary), which used a staining solution. At the same time, occlusal problems caused by missing tooth/teeth, decay, and orthodontic problem were confirmed.Results : Statistical analysis by multiple regression analysis reveals that age ; plaque accumulation status, and living environment have very significant influences to the periodontal inflammatory status. The result demonstrates the situation of the living environment as a significant influence to the cause of periodontal inflammation.Conclusion : The poor living and unsanitary environment may provide the vicious cycle of recurrent or prolonged infections leading to severe oxidative changes caused by the hyper functioning immune system. The end result of which is a hastened aging process. Therefore, a better living environment for the rural area residents is a must in order to prevent periodontal infections, as well as infectious tropical diseases.

Assessing the Accuracy of Administrative Data in Health Information Systems

Administrative data play a central role in health care. Inaccuracies in such data are costly to health systems, they obscure health research, and they affect the quality of patient care. We sought to prospectively determine the accuracy of the primary and secondary diagnoses recorded in administrative data sets. Between March and July 2002, standardized patients (SPs) completed unannounced visits at 3 sites. We abstracted the 348 medical records from these visits to obtain the written diagnoses made by physicians. We also examined the patient files to identify the diagnoses recorded on the administrative encounter forms and extracted data from the computerized administrative databases. Because the correct diagnosis was defined by the SP visit, we could determine whether the final diagnosis in the administrative data set was correct and, if not, whether it was caused by physician diagnostic error, missing encounter forms, or incorrectly filled out forms. General internal medicine outpatient clinics at 2 Veterans Administration facilities and a large, private medical center participated in this study. A total of 45 trained SPs presented to physicians with 4 common outpatient conditions. The correct primary diagnosis was recorded for 57% of visits. Thirteen percent of errors were caused by physician diagnostic error, 8% to missing encounter forms, and 22% to incorrectly entered data. Findings varied by condition and site but not by level of training. Accuracy of secondary diagnosis data (27%) was even poorer. Although more research is needed to evaluate the cause of inaccuracies and the relative contributions of patient, provider, and system level effects, it appears that significant inaccuracies in administrative data are common. Interventions aimed at correcting these errors appear feasible.

Dermoscopic patterns of benign volar melanocytic lesions in patients with atypical mole syndrome.

Acral benign melanocytic lesions in white populations, particularly in subjects with atypical mole syndrome, have been poorly characterized until recently. The advent of dermoscopy has enabled more specific diagnoses of these pigmented skin lesions. To evaluate the clinical and dermoscopic features of benign volar lesions in a group of white patients with atypical mole syndrome. A private medical center specializing in early diagnosis of malignant melanoma and a melanoma unit in a university hospital. Acral melanocytic lesions in 511 patients with atypical mole syndrome were studied using standard clinical assessment and dermoscopy. Two hundred ten acral melanocytic lesions were observed in 156 of the patients: 165 lesions were present on the soles of 121 patients and 45 lesions on the palms of 35 patients. No acral malignant lesions were detected. We observed the following patterns of lesions: parallel furrow in 111 lesions (52.9%), latticelike in 26 lesions (12.4%), fibrillar or filamentous in 13 lesions (6.2%), and nontypical in 29 lesions (13.8%). In 31 lesions (14.8%), we observed 3 previously undefined patterns: a globular pattern in 11 lesions (5.2%), a homogeneous pattern in 15 lesions (7.1%), and an acral reticular pattern in 5 lesions (2.4%). We observed a greater number of benign melanocytic lesions in glabrous skin than expected, probably related to our cohort selection of patients with atypical mole syndrome, although the lesions generally exhibited patterns on dermoscopy similar to those seen in Japanese studies. We defined 3 new benign dermoscopic patterns, which will enable better characterization of acral lesions.

Latin-American Gastrointestinal Endoscopy Training Center

Latin-American Gastrointestinal Endoscopy Training Center

Effect of caregiver perception of preparedness on burden in an oncology population.

To identify the level of lay caregiver burden and perception of preparedness that exists for the oncology population prior to and just after hospital discharge. Descriptive, correlational design using repeated measures. Large, tertiary care, private medical center in the midwestern United States. 59 lay caregivers of patients with cancer who were discharged from inpatient hospital status. Caregivers completed Robinson's Caregiver Strain Index and Archbold's Preparedness Scale questionnaires immediately prior to discharge, 7-10 days postdischarge, and 28-30 days postdischarge. Caregivers' perception of preparedness and burden. Preparedness levels ranged from "somewhat" to "pretty well" prepared and were consistent over time. Burden levels were moderate and also consistent over time. Increased levels of preparedness were associated with decreased levels of burden, and that relationship was consistent over time. Caregivers' levels of preparedness can be enhanced, although no significant differences were reported in the period from prehospital discharge to one month following discharge. Burden experiences of caregivers are real and not affected by the transition from hospital to home. Burden experiences can be influenced by perceptions of preparedness. Efforts to enhance the preparedness of lay caregivers can influence their burden experience.